By: Cristina N. Hyde, JD

Last month, United States Congresswoman Suzan DelBene, introduced the Improving Seniors’ Timely Access to Care Act of 2021, for consideration.  If successful, this new law would amend title XVIII of the Social Security Act in order to address prior authorization practices with the goal of streamlining the process in order to avoid unnecessary delays in patient care.

H.R. 3173 recognizes the practice burdens associated with the pre-authorization process which requires physicians to obtain pre-approval before providing patient care.  It also acknowledges the detrimental effect of the tedious process on quality and continuity of care.  Therefore, the Act would establish requirements with respect to the use of prior authorizations under Medicare Advantage plans and hopefully expand to other insurers once positive precedent has been set.  Highlights of the legislation include mandates to:

• Establish an electronic prior authorization program and require the Medicare Advantage Plan to adopt that program.
• Establish a real-time decision making process with respect to prior authorization requests for certain enumerated items and services.
• Increase transparency around prior authorizations through annual reporting of the percentage of prior authorization requests that were submitted, approved or denied, appealed, etc.

You can find more information about the patient and physician impact of the prior authorization process, on the American Medical Association’s website where they have published a detailed 2020 physician survey containing statistical analysis of the frequency with which the pre-authorization process delays care or causes patients to abandon treatment, among other outcomes.

Campanella Law Office strongly supports the Improving Seniors’ Timely Access to Care Act and we urge you to call your congressional representatives and emphasize the necessity of this reform.  You can find your Representative and information on how to contact them here.